Costochondritis – A Common Cause of Chest Pain

Chest pain is one of the scariest symptoms a person can have because the first thing we usually think of is a heart attack. Of course, any new chest pain should be considered a medical emergency and checked out right away. But once a heart problem has been ruled out, one of the possibilities your doctor may consider is costochondritis.

Costochondritis ((kos-toe-KHON-dri-tis) is an inflammation of the cartilage that connects a rib to the breastbone (sternum). It is one of the most common cause of musculoskeletal chest pain.

Symptoms:

The two main symptoms of costochondritis are pain and tenderness in the chest wall, specifically where the ribs attach to the breastbone.

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Pain – The pain of costochondritis is usually described as sharp and/or stabbing, but may also be dull, burning or gnawing. Often the pain gets worse when coughing or taking a deep breath. There may also be some difficulty breathing. The location of the pain can be on either or both sides of the breastbone, but usually only occurs on one side.

Tenderness – Tenderness when you press on the area where the ribs meet the breastbone is a characteristic feature of costochondritis.

When the pain and tenderness is accompanied by swelling, it is called Tietze syndrome rather than costochondritis.

Causes and Risk Factors:

Most cases of costochondritis have no known or obvious cause. There are some cases, however, that do have a clear cause. Some of those causes include:

An injury or blow to the chest.

Heavy lifting or strenuous exercise that strains the ribcage.

An upper respiratory illness that involves a lot of sneezing or coughing.

A bacterial or fungal infection that may sometimes occur, usually only in patients who are intravenous drug users or following thoracic surgery.

Costochondritis is also known to occur as a comorbid condition with other chronic illnesses such as:

Costochondritis can be challenging to diagnose because its symptoms are so similar to other illnesses like heart disease, lung disease and osteoarthritis. Although costochondritis can't usually be seen on x-rays and other imaging tests, your doctor may order them as well as tests like an electrocardiogram (ECG or EKG) in order to rule out the other possible conditions.

Personal history and a physical exam are the main components needed in diagnosing costochondritis. As part of the physical exam, your doctor will most likely press on the area where your ribs meet your breastbone to determine whether it is tender and sore, since that is a key symptom of costochondritis.

Treatment:

Treatment for costochondritis is aimed at reducing inflammation and easing the pain. Following are the medications most often used:

The first line of treatment is usually over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, naproxen or aspirin.

If the pain is causing sleep difficulties, tricyclic antidepressants may be prescribed. Antidepressants can be effective pain relievers and can enhance sleep.

Muscle relaxants may also be prescribed to help reduce pain.

If other medications are not helping, cortisone injections into the inflammed area can be effective in easing the pain.

In cases where costochondritis is caused by infection, antibiotics would be prescribed.

In severe cases that don't respond to medication, surgery may be required to remove the affected cartilage.

Some things you can do at home to help include:

Rest and avoid activities that strain and aggrevate the painful area.

Try applying ice packs or moist heat or alternating the two for no more than 20 minutes at a time.

Prognosis:

Although costochondritis can be extremely painful, it is considered a benign condition and is not life threatening. Most people recover completely, but recovery time can vary greatly from patient to patient. For some, costochondritis goes away in just a few days; for others it may last for several months. About half of costochondritis patients will still have some discomfort after one year. For some patients, however, costochondritis can become a chronic recurring problem. This seems to be particularly prevalent in people with fibromyalgia.